{"abstract":"Subpart R of 42 CFR part 405 consists of regulations governing Medicare reimbursement determinations, and appeals of those determinations, by health care providers. (For the sake of simplicity, throughout this final rule, we use \"reimbursement\" to refer to Medicare payment under both the reasonable cost and prospective payment systems.) Under section 1878 of the Social Security Act (the Act) and the subpart R regulations, the Provider Reimbursement Review Board (the Board) has the authority to adjudicate certain substantial reimbursement disputes between providers and fiscal intermediaries (intermediaries). Board decisions are subject to review by the CMS Administrator, and the final agency decision of the Board or the Administrator, as applicable, is reviewable in Federal district court. In addition, under the subpart R regulations, intermediaries have the authority to hold hearings and adjudicate certain other payment and reimbursement disputes with providers. This final rule updates, clarifies, and revises various provisions of the regulations governing provider reimbursement determinations, appeals before the Board, appeals before the intermediaries (for lesser disputes), and Administrator review of decisions made by the Board.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2008/05/23/E8-11227.html","cfr_references":[{"chapter":null,"citation_url":null,"part":405,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":417,"title":42}],"citation":"73 FR 30190","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Date: These regulations are effective August 21, 2008.","disposition_notes":null,"docket_ids":["CMS-1727-F"],"dockets":[],"document_number":"E8-11227","effective_on":"2008-08-21","end_page":30267,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2008/05/23/E8-11227.xml","html_url":"https://www.federalregister.gov/documents/2008/05/23/E8-11227/medicare-program-provider-reimbursement-determinations-and-appeals","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/E8-11227?publication_date=2008-05-23","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2008-05-23/E8-11227/mods.xml","not_received_for_publication":null,"page_length":78,"page_views":{"count":1418,"last_updated":"2026-08-25 00:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2008-05-23/pdf/E8-11227.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2008-05-23","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2008/05/23/E8-11227.txt","regulation_id_number_info":{"0938-AL54":{"issue":"200804","html_url":"https://www.federalregister.gov/regulations/0938-AL54/provider-reimbursement-determinations-and-appeals-cms-1727-f-","title":"Provider Reimbursement Determinations and Appeals (CMS-1727-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200804&RIN=0938-AL54&operation=OPERATION_EXPORT_XML","priority_category":"Substantive, Nonsignificant"}},"regulation_id_numbers":["0938-AL54"],"regulations_dot_gov_info":{"checked_regulationsdotgov_at":"2011-11-14T05:22:44Z"},"regulations_dot_gov_url":null,"significant":false,"signing_date":null,"start_page":30190,"subtype":null,"title":"Medicare Program; Provider Reimbursement Determinations and Appeals","toc_doc":"Provider Reimbursement Determinations and Appeals","toc_subject":"Medicare Program:","topics":["Administrative practice and procedure","Grant programs-health","Health care","Health facilities","Health insurance","Health maintenance organizations (HMO)","Health professions","Kidney diseases","Loan programs-health","Medical devices","Medicare","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Rule","volume":73}